NPIMap

Organization Active NPI

Van Buren Community Mental Health Authority

  • Child & Adolescent Psychiatry Physician
  • Hartford, MI
National Provider Identifier
1982916045
Registry record updated Jul 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Practice address
57418 CR 681
Suite C
Hartford, MI 49057
Phone
(269) 621-6251
Fax
(269) 621-6044
NPI assigned
Jul 6, 2010
Organization subpart
Yes
Parent organization
VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Debra L-R Hess
Title
C.E.O.
Phone
(269) 657-5574

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X Primary

Addresses

Primary practice location

57418 CR 681
Suite C
Hartford, MI 49057

Mailing address

P.O. Box 249
801 Hazen Street Suite C
Paw Paw, MI 49079-0249
Phone (269) 657-5574

Other identifiers 1

IdentifierTypeStateIssuer
1705298MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Van Bure Community Mental Health6 organizations share this tax ID, including this one
Part of
Van Bure Community Mental Health

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

57418 County Road 681
Ste C
Hartford, MI 49057
Phone (269) 621-6251

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1982916045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 249",
            "address_2": "801 HAZEN STREET SUITE C",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790249",
            "telephone_number": "269-657-5574",
            "fax_number": "269-657-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57418 CR 681",
            "address_2": "SUITE C",
            "city": "HARTFORD",
            "state": "MI",
            "postal_code": "49057",
            "telephone_number": "269-621-6251",
            "fax_number": "269-621-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY",
        "enumeration_date": "2010-07-06",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "L-R",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "269-657-5574",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1705298",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.